PLoS One. Conventional cytology was performed and evaluated according to the criteria of Bethesda 2001. The clearance rate is increasing gradually after surgery. It is always possible that a few (or more) cells may have found their way out without leaving a detectable tumor at the margin. PMID:10793105. We included in the study all patients with HSIL cytology on PAP smear that had no previous treatment for cervical lessions, who were referred for LEEP to the department of obstetrics and gynecology of the University of Medicine and Pharmacy “Victor Babeș” Timișoara, between January 2010 and June 2015. PMID:16991121. PMID:12807939. Virtually all cervical cancers are caused by persistent high-risk human papillomaviruses (HR-HPV) infection [1–3]. doi:10.3802/jgo.2009.20.2.91. All patients were evaluated by colposcopy and International Federation for Cervical Pathology and Colposcopy (IFCPC) criteria were used. A Tudor – PhD and Senior Consultant of Department of Informatics and Biostatistics University of Medicine and Pharmacy “Victor Babeş” Timişoara, Romania. BJOG. PMID:16950021. PMCID:PMC2705006. Your pathology report should have mentioned if the tissue removed had “clear margins”. statement and The DNA of 37 HPV types (6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 45, 51, 52, 53, 54, 55, 56, 58, 59, 61, 62, 64, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, IS39 and CP6108) was detected in cervical samples by multiplex PCR targeted to the conserved L1 region of the viral genome. Moreover, the cases with cytological abnormalities are referred to specialized centers. Despite the removal of the entire lesion by cone excision, with negative margins, the HPV infection can persist in some cases. High persistence rates, similar to ours, were found only by Song et al [14], who reported a persistence rate of 43.8 % at 6 months in patients with high viral load before LEEP [14]. P Matusz – Professor Department of Anatomy University of Medicine and Pharmacy “Victor Babeş” Timişoara, Romania. The results are shown in Table 6. PubMed Central  Correspondence to HELP!!! Patients were first evaluated trough the national screening program. That means that all the abnormal cells were in the middle with clear, healthy tissue all around the edges. Your pathology report may say that the surgical margins are: Clear (also called Negative or Clean): No cancer cells are seen at the outer edge of the tissue that was removed (the tumor along with the rim of surrounding tissue). Verguts J, Bronselaer B, Donders G, et al. Natural History of Progression of HPV Infection to Cervical Lesion or Clearance: Analysis of the Control Arm of the Large, Randomised PATRICIA Study. Diagnoses and outcomes in cervical cancer screening: a population-based study. We identified a persistence rate higher than the one reported by other authors: Kim et al [13] reported a persistence rate of 14.3 %, 2.2 % and 1.1 % at 6, 12 and 18 months. Since the presence of positive margins is considered a major factor for HPV persistence and disease recurrence and progression, we excluded patients with positive margins after resection from our study, as we wanted to investigate the persistence of HPV infection in patients with negative margins. 2006;24 Suppl 3:S3/78–89. CAS  DG, OM, PM, LM, AT, FH performed the analysis and interpretation of data. Age and HPV type as risk factors for HPV persistence after loop excision in patients with high grade cervical lesions: an observational study. LP, MP and CS performed the surgery and conceived and designed the study, were responsible with acquisition of data. The standard procedure for conservative management of high-grade CIN is large loop excision of the transformation zone (LEEP) or conization. Google ScholarÂ. Follow up visits were scheduled at 6, 12 and 18 months after surgery. Therefore, appropriate management is essential in terms of cancer prevention [7, 8]. If you get all of the bruise, plus some of … This article was supported by the grant PII-C2-TC-2014-06 University of Medicine and Pharmacy “Victor Babeș” Timișoara, Romania. We found no significant differences between the persistence rate for co-infections including type 16 versus infection with type 16 alone. Patients who were negative for HPV DNA before LEEP were excluded from the study. Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ). Those with cytological abnormalities were referred to our center. Persistent infections with high risk human papillomaviruses (HR-HPV) cause virtually all cervical cancers. PubMed Central  The prevalence of HPV infection in women older than 30 is significantly lower than that described in younger women at the mean age of the first sexual intercourse. 2009;20(2):91–5. The remaining 110 patients were followed up. Margins are checked after surgical biopsy, lumpectomy, and mastectomy. 2013;8(11):e79260. Another Pap smear was performed and patients with HSIL were referred to our department. Type 16 showed the highest persistence rate: 27.3 % at 6 months, 12.7 % at 12 months and 10 % at 18 months after LEEP. Women with persistent low-grade or high-grade cervical dysplasia may be recommended to have a procedure called a LEEP. PubMed Google Scholar. Informed consent was obtained from all patients prior to their inclusion in the study. doi:10.1016/j.ygyno.2007.11.009. J Natl Cancer Inst. Genital HPV infection is presumably the most prevalent sexually transmitted infection [4]. volume 16, Article number: 70 (2016) The recommendation for this patient would be … Here it goes DIAGNOSIS: 1) Moderate squamoud dysplasia Cin 11 showing focal involvement of the endocervical surgical I finally received word today that my pap was normal and negative for HPV. Vaccine. Our results indicate that HPV type 16 has the lowest clearance rate. It is important to note that the finding of negative margins does not mean that the cancer cells have been completely contained in the resected specimen. DNA HPV testing was performed for each patient at each visit. PMCID:PMC3469856. Data collection was complete for all 110 patients at each time point and the study visits were balanced individually for every patient at 6 months apart. Every procedure was performed by the same team of surgeons. The median age in our group was 36.5 years. By using this website, you agree to our PMID:12893200. CAS  2010;126(8):1903–9. According to the findings of Jaisamrarn et al [20], concomitant HPV infection increase the risk of progression to a lesion, suggesting that multiple HPV infections could influence disease progression. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. As you were browsing something about your browser made us think you were a bot. Article  ICO Information Centre on HPV and Cancer (HPV Information Centre). The specimen margins are reported as clear in 59% to 92% of women undergoing a cold knife conization. L Moleriu – PhD and Senior Consultant of Department of Informatics and Biostatistics University of Medicine and Pharmacy “Victor Babeş” Timişoara, Romania. 2012;23(4):217–25. J Gynecol Oncol. All procedures have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments and were approved by the Institutional Review Board and Ethical Committee of “Victor Babeş” University of Medicine and Pharmacy Timişoara – reference number of ethics approval 20/2010. 1/12/16 Massive bleed & large clots 2wks after lletz. All specimens were sent to histopathological exam. A total of 129 patients were referred to our clinic with HSIL on PAP Smear test. We consider that our high rate of patients co-infected with multiple HPV types is due to the selection of patients with HSIL only [20]. 2/12/16 Seen at colposcopy clinic. We did not find in literature data about age as a risk factor for the persistence of HPV type 16 alone. In those with a negative LEEP margin, post-LEEP cytology results were normal in mild in 40, 30, and severe in There was no correlation 7. between follow-up cytology result and positive or negative margin status (p=0.56). I am a bit confused about clear margins and involved margins. PMID:18177929, Epub 2008 Jan 4. I had my LEEP last week and my results are in. 2011;129(4):903–9. J Clin Virol. The datasets on which the conclusions of the manuscript rely are presented in an Additional file 1. Article  Arbyn M, Sasieni P, Meijer CJ, Clavel C, Koliopoulos G, Dillner J. doi:10.1016/S0140-6736(06)68181-6. Int J Cancer. The authors declare that they have no competing interests. Although LEEP does not completely eradicate HPV infection, our results indicate that most HR-HPV infections are cleared after LEEP with negative margins. I return in 3 months. Those with a normal HPV test after LEEP have a very low risk of having further high-grade cell changes (cervical intraepithelial neoplasia grade 2 or 3) in the near future. J Clin Pathol. This graphic shows patient distribution according to the age of the patients. The persistence for HPV type 16 at 6 months after LEEP was significantly higher in the group > =36.5 years old compared to the persistence rate in the group <36.5 years old (p = 0.0027, RR = 2.75, 95 %ϵ(1.34; 5.64)) (see Table 3). Having clear margins or negative margins from one of these procedures is a good indication that all of the dysplasia was removed and likely nothing was left behind. Gynecol Oncol. The LEEP procedure side effects are usually mild. The HPV test was negative in 12 patients with HSIL and they were also excluded. Bruni L, Barrionuevo-Rosas L, Albero G et al. This fairly common condition is known as cervical dysplasia, or pre-invasive cervical disease. There is 4 samples. Jaisamrarn U, Castellsagué X, Garland SM, et al. Kim et al [13], Heymans et al [11] and Nam et al [10] also found that HPV type 16 is a factor for infection persistence after treatment. Lancet. Article  Close: There are cancerous cells in the margin, but they don’t extend all the way to the edge. Manage cookies/Do not sell my data we use in the preference centre. A LEEP is commonly recommended for women whose cervical biopsy results show abnormal cells on the cervix that may progress into cervical cancer if left untreated. Clear margins means that when they did the procedure (LEEP or cold knife cone), all the bad tissue was removed, plus some healthy tissue surrounding it. Chapter 9: Clinical applications of HPV testing: a summary of meta-analyses. HPV persistence rate after LEEP is higher in infections with type 16 and in women older than 36.5 years. Lowy DR, Solomon D, Hildesheim A, Schiller JT, Schiffman M. Cancer. 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